A large and growing population of patients survives acute critical illness only to become "chronically critically ill," with profound debilitation and often permanent dependence on life-sustaining technology. Despite intensive care, outcomes for these patients remain poor: mortality rates are high and extreme functional dependence is typical for survivors. Evidence suggests substantial patient suffering during care. Chronic critical illness is a serious health problem for the nation and especially for older adults; the majority of these patients are over age 65. The Candidate for this K02 award brings expertise in critical care and palliative medicine to this important new area for aging research. Overall goals of her research program are: I. To assess palliative care needs of chronically critically ill older adults; II. To evaluate the influence of unmet palliative needs on important clinical/utilization outcomes of chronic critical illness; and III. To test targeted interventions to improve palliative care/associated outcomes of older adults with chronic critical illness. She recently received her first R01 award for research with these specific aims: 1) To assess symptom distress during chronic critical illness; and 2) To analyze associations between symptom experience and other outcomes including success in/time to liberation from mechanical ventilation, functional status and survival. [unreadable] Here, the Candidate presents a plan for further career development/research that will enhance the current R01 and facilitate her transition from newly independent investigator to leader of a strong, expansive, and sustainable program that continues to inform and improve palliative care for older adults with chronic critical illness. Whereas she currently carries substantial non-research responsibilities, a K02 award would protect the Candidate's time to: 1) Advance her skills/knowledge/experience in clinical research methods/project leadership, palliative medicine and geriatrics; 2) Use her ongoing observational research as a platform for successful applications for federal funding of interventional studies; and 3) Establish herself as an investigator of international stature. The environment is a renowned center for research in geriatric palliative care and chronic critical illness and for clinical research training; the institution offers enthusiastic support. [unreadable] [unreadable]